Efficacy of Therapeutic Exercise for Recurrent Back Pain

描述（由申请人提供）：腰背部疾病是活动受限的主要原因，高达47%的受伤工人受到影响。虽然大多数（80%至90%）急性腰痛患者在受伤后四周内恢复，但60%至86%的患者在急性发作后的一年内会再次出现背痛。腰椎稳定练习通常用于腰痛的康复计划，其理论基础是由于肌肉损伤、无力、肌肉协同激活模式改变和反应延迟导致脊柱神经肌肉控制不足，这是疼痛和复发性损伤的一个来源。因此，有必要确定治疗性运动是否可以提高稳定性，并确定治疗所针对的神经肌肉控制因子是否有助于稳定性。特定稳定训练（SSE）包括一系列训练，最初强调与脊柱相连的深层肌肉（多裂肌和腹横肌）的招募和协同激活，以实现局部腰椎节段控制。之后，练习的重点是在中性姿势下招募更大的躯干肌肉来控制躯干平衡。在一个小队列患者中出现的新证据表明，SSE训练可以减轻疼痛，改善功能，并降低治疗后3年内腰痛复发的风险。在拟议的研究中，51名符合稳定运动治疗指征的急性复发性腰痛患者将接受10周的SSE训练。临床结果（疼痛和功能）和生物力学测量（局部和整体运动控制指标）将在第5周和第11周进行评估。统计分析将比较SSE训练随时间的变化，并将有LBP的受试者与51名没有LBP的受试者进行比较。本研究的目的是确定局部和全局神经肌肉控制因素，有助于复发性腰痛患者的潜在不稳定状态。我们将确定SSE训练是否以及何时能改善复发性腰痛患者的这些因素。我们将研究神经肌肉控制的局部和整体因素的改善与疼痛和功能状态的临床重要改善之间的关系，该研究将启动本研究计划并开发试点统计数据，以促进设计大规模，前瞻性，随机对照试验。

DESCRIPTION (provided by applicant): Low back disorders are the leading cause of activity limitation and affect up to 47% of injured workers. While the majority (80% to 90%) of individuals with acute low back pain (LBP) recover by four weeks post injury, 60% to 86% of these patients will experience recurrent back pain during the year after the acute episode. Lumbar stabilization exercises are commonly used in rehabilitation programs for LBP, based on the theory that a source of pain and recurrent injury is inadequate neuromuscular control of the spine resulting from muscle damage, weakness, altered muscle coactivation patterns, and delayed responses. Therefore, it is necessary to determine whether stability can be improved by therapeutic exercise and determine whether neuromuscular control factors targeted by treatment contribute to stability. Specific Stabilization Exercise (SSE) involves a progression of training which initially emphasizes recruitment and coactivation of the deep muscles attached to the spine (multifidus and transverse abdominis) for local, lumbar segmental control. Later, exercises focus on recruitment of larger trunk muscles in neutral postures for trunk equilibrium control. Emerging evidence on a small cohort of patients indicates that SSE training reduces pain, improves function, and reduces the risk of low back pain recurrence up to 3 years post treatment. In the proposed investigation, 51 persons with acute, recurrent LBP who meet indications for stabilization exercise therapy will undergo 10-weeks of SSE training. Clinical outcomes (pain and function) and biomechanical measurements (local and global indices of motor control) will be evaluated at weeks 5 and 11. Statistical analyses will compare the change over time with SSE training and will compare the subjects with LBP to 51 subjects without LBP. The goal of this study is to identify local and global neuromuscular control factors that contribute to a state of potential instability in individuals with recurrent LBP. We will determine if and when SSE training improves these factors in persons with recurrent LBP. We will investigate the relationships between improvements in local and global factors of neuromuscular control and clinically important improvements in pain and functional status, The proposed study will initiate this research program and develop pilot statistics to facilitate the design of a large scale, prospective, randomized controlled trial.